HESI CASE STUDY LOSS, GRIEF, DEATH
Patient Situation Overview
- Client Profile: Elderly woman, one year post-stroke, has right-sided paralysis and dysphagia. Home care
helps from spouse and home health nurse.
- Incident: While eating soup, the client chokes, coughs, appears short of breath, and experiences a
decline in level of consciousness (LOC) over the following days, with increased temperature and
diminished breath sounds.
Nursing Assessments and Actions
1. Priority Immediate Assessment after Choking Incident:
- Choice: B. Auscultate the client's lungs for adventitious breath sounds.
- Rationale: It is crucial to assess the lungs for signs of aspiration pneumonia due to the choking
incident. Adventitious sounds indicate possible fluid in the lungs or infection.
2. Best Course of Action After Assessment Findings:
- Choice: A. Report the assessment findings to the health care provider.
- Rationale: The evidence of decreased LOC, fever, and abnormal lung sounds requires notifying the
healthcare provider for further evaluation and possible intervention, such as admission to the hospital.
Legal Considerations Regarding Advance Directives
3. Nurse’s Responsibility During Admission:
- Choice: A. Determine if the client has completed a Living Will and a durable power of attorney for
healthcare (DPAHC).
- Rationale: It's essential to ensure the client's wishes regarding medical treatment are documented
and respected. The Patient Self-Determination Act emphasizes the need to inquire about advance
directives.
4. Subsequent Action Related to Living Will:
- Choice: B. Place a copy of the Living Will in the medical record and document its presence.
- Rationale: The Living Will must be part of the medical record to ensure that the client’s treatment
preferences are accessible and can guide medical decisions.
, Additional Considerations
- Communication with Spouse: Ensuring that the spouse feels heard and supported during this difficult
time is vital.
- Focus on Comfort: The nurse reassures the spouse about the focus on the client's comfort, which is
consistent with the desires expressed in the Living Will.
Nutritional IssuesThe client is diagnosed with pnuemonia and is prescribed intravenous antibiotics for
treatment. The client's swallow study determined that she should be on honey thick liquids and pureed
foods. The spouse comes to visit the client and notices the "Swallow Precautions- thickened liquids" sign
and asks the nurse what it means. The nurse explains since the client does not have adequate
swallowing ability thin liquids may go into the trachea and then the lungs instead of the stomach and
cause pneumonia. Suddenly, the spouse gets a shocked look on his face and says, "Oh, no! I did that. I
gave her pneumonia?"
What is the nurse's best response?
A. "How was she positioned when you fed her?"
B. "Saliva entering the lungs can also cause pneumonia. And you did not have a way of knowing she was
aspirating."
C. "You know you did the best you could."
D. "We know it was not intentional on your part." ✔️B. "Saliva entering the lungs can also cause
pneumonia. And you did not have a way of knowing she was aspirating."
Four days later, the client becomes more disoriented and she is unable to swallow thickened liquids or
pureed foods without choking. Her weakness has progressed to the point at which she cannot bear her
own weight or sit in a chair. The healthcare provider suggests inserting a nasogastric feeding tube to
provide nutrition; however, the client's Living Will excludes tube feedings and intravenous nutrition. The
client's spouse states they support the client's decision and this information was shared with their adult
child.
Which response demonstrates that the nurse understands the underlying premise of a Living Will?
A. "We will honor the directives in her Living Will."
B. "Are you sure that this is what you really want for the client?"
Patient Situation Overview
- Client Profile: Elderly woman, one year post-stroke, has right-sided paralysis and dysphagia. Home care
helps from spouse and home health nurse.
- Incident: While eating soup, the client chokes, coughs, appears short of breath, and experiences a
decline in level of consciousness (LOC) over the following days, with increased temperature and
diminished breath sounds.
Nursing Assessments and Actions
1. Priority Immediate Assessment after Choking Incident:
- Choice: B. Auscultate the client's lungs for adventitious breath sounds.
- Rationale: It is crucial to assess the lungs for signs of aspiration pneumonia due to the choking
incident. Adventitious sounds indicate possible fluid in the lungs or infection.
2. Best Course of Action After Assessment Findings:
- Choice: A. Report the assessment findings to the health care provider.
- Rationale: The evidence of decreased LOC, fever, and abnormal lung sounds requires notifying the
healthcare provider for further evaluation and possible intervention, such as admission to the hospital.
Legal Considerations Regarding Advance Directives
3. Nurse’s Responsibility During Admission:
- Choice: A. Determine if the client has completed a Living Will and a durable power of attorney for
healthcare (DPAHC).
- Rationale: It's essential to ensure the client's wishes regarding medical treatment are documented
and respected. The Patient Self-Determination Act emphasizes the need to inquire about advance
directives.
4. Subsequent Action Related to Living Will:
- Choice: B. Place a copy of the Living Will in the medical record and document its presence.
- Rationale: The Living Will must be part of the medical record to ensure that the client’s treatment
preferences are accessible and can guide medical decisions.
, Additional Considerations
- Communication with Spouse: Ensuring that the spouse feels heard and supported during this difficult
time is vital.
- Focus on Comfort: The nurse reassures the spouse about the focus on the client's comfort, which is
consistent with the desires expressed in the Living Will.
Nutritional IssuesThe client is diagnosed with pnuemonia and is prescribed intravenous antibiotics for
treatment. The client's swallow study determined that she should be on honey thick liquids and pureed
foods. The spouse comes to visit the client and notices the "Swallow Precautions- thickened liquids" sign
and asks the nurse what it means. The nurse explains since the client does not have adequate
swallowing ability thin liquids may go into the trachea and then the lungs instead of the stomach and
cause pneumonia. Suddenly, the spouse gets a shocked look on his face and says, "Oh, no! I did that. I
gave her pneumonia?"
What is the nurse's best response?
A. "How was she positioned when you fed her?"
B. "Saliva entering the lungs can also cause pneumonia. And you did not have a way of knowing she was
aspirating."
C. "You know you did the best you could."
D. "We know it was not intentional on your part." ✔️B. "Saliva entering the lungs can also cause
pneumonia. And you did not have a way of knowing she was aspirating."
Four days later, the client becomes more disoriented and she is unable to swallow thickened liquids or
pureed foods without choking. Her weakness has progressed to the point at which she cannot bear her
own weight or sit in a chair. The healthcare provider suggests inserting a nasogastric feeding tube to
provide nutrition; however, the client's Living Will excludes tube feedings and intravenous nutrition. The
client's spouse states they support the client's decision and this information was shared with their adult
child.
Which response demonstrates that the nurse understands the underlying premise of a Living Will?
A. "We will honor the directives in her Living Will."
B. "Are you sure that this is what you really want for the client?"
